Cardiovascular benefits of GLP-1 agonists in cancer patients with T2DM

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Created On: 14/02/2025

Immune checkpoint inhibitors (ICIs) are known to markedly escalate the likelihood of major adverse cardiovascular events (MACE).

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Key take away

In cancer-affected individuals with T2DM receiving immune checkpoint inhibitors, the use of glucagon-like peptide-1 agonists reduces cardiovascular events without increasing the risks of severe complications.

Background

Immune checkpoint inhibitors (ICIs) are known to markedly escalate the likelihood of major adverse cardiovascular events (MACE). Meanwhile, glucagon-like peptide-1 agonists (GLP1a), originally developed to tackle type 2 diabetes mellitus (T2DM), have emerged as promising agents for reducing cardiovascular risks. Hence, a retrospective study determined the potential of GLP1a in alleviating cardiovascular events among cancer sufferers receiving ICIs.

Method

This propensity score-matched cohort study harnessed the TriNetX database. Adult patients with cancer and T2DM who received ICIs were incorporated. The key endpoint ascertained was the occurrence of MACE. This was described as a composite of cardiac arrest, coronary revascularization, heart failure, ischemic stroke, and myocardial infarction.

Secondary endpoints encompassed individual MACE components, as well as pericarditis and myocarditis. Safety outcomes focused on all-cause mortality, immune-linked adverse events, and serious GLP1a-linked adverse events.

Result

Of the 7,651 eligible volunteers, 479 were treated with GLP1a, while 7,172 received non-GLP1a diabetes medications. After matching (469 patients in each group), baseline characteristics were well-balanced. Over a median follow-up of 12 months, the GLP1a cohort illustrated a striking 54% reduction in the risk of MACE when compared to the non-GLP1a group (9.0 versus 17.1 events per 100 patient-years; Hazard ratio [HR], 0.46).

Notable decreases were reported in all-cause mortality, coronary revascularization, heart failure, and myocardial infarction. No vital differences were observed in other cardiovascular events. Importantly, GLP1a use was not linked with an increased risk of adverse events, including gastroparesis, biliary disease, bowel obstruction, immune-linked complications, or pancreatitis.

Conclusion

Using GLP1a in cancer patients with T2DM undergoing ICI therapy was linked to a remarkable reduction in MACE and all-cause mortality. Importantly, this benefit occurred without an increased risk of serious adverse events, highlighting its potential as a valuable adjunct in this high-risk population.